Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0701005499 | VA |
NPI | 1114327699 |
---|---|
Provider Name | Mr. Wayne Oliver Powell |
First Address | Roanoke, VA 24018-3536 |
Second Address | Roanoke, VA 24018-3536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2014 |
Last Update Date | 03/09/2014 |